Wednesday, August 02, 2006

Many immigrants to the United States may be getting inadequate medical care because of language barriers between patients and medical professionals. In response, some health facilities are working to add more multilingual staff and reduce errors based on miscommunication.

More than 22 million people who live in the United States don't speak or understand English very well. And that can be deadly. In a study published in the New England Journal of Medicine, Dr. Glenn Flores highlights some cases where language barriers prevented patients from communicating with health care providers -- with serious consequences.

Flores recalls one incident in which English-speaking paramedics thought a Spanish-speaking man was suffering from a drug overdose. "He was in the hospital basically for two days being worked up for drug abuse," Flores says. "They finally did a head C-T scan and realized he had had a major bleed into his brain, probably originating from the rupture of an artery in his brain. He ended up being quadriplegic and he got a $71 million settlement award from the hospital."

Flores, a professor at the Medical College of Wisconsin says that despite examples like that, the majority of U.S. health care facilities still do not have trained interpreters on site. But he acknowledges that increasing numbers of health care workers are bilingual, and that more clinics and hospitals do make sure their staff and patients understand each other.

The Sixteenth Street Community Health Center is in a largely Hispanic neighborhood of Milwaukee, Wisconsin. Some 40%, or about 7000 of the patients who were seen there last year spoke little or no English. Fortunately for them, of the 30 doctors and nurses at the clinic, 28 also speak Spanish.

Dr. Enriquez examines a patient at the Sixteenth Street ClinicOne of them is Guatemalan-born pediatrician Francisco Enriquez. He says being able to speak to his patients in their native language means he can discuss their condition - and treatment - in much greater depth. "It's always good to ask a few extra questions," he explains, "such as why this is important for you and what have you heard and what do other people say about this? Sometimes that helps you understand what their real concerns are. But it's difficult to get into that detail if you don't speak the language."

The Sixteenth Street Clinic is expanding. So its directors are in the process of hiring more staff who are bilingual, or who commit to learning Spanish. Clinic vice-president, Dr. Julie Schuller, says new hires are told that by speaking to patients in their own language, they can provide the highest quality care. "By providing high quality care, we are avoiding errors, we are avoiding malpractice suits," she says. "The main focus for us is the high quality. What [follows] from that [i.e. avoiding errors] is important too, but we're focused on providing the best quality we can provide."

Dr. Schuller at workSchuller says it's frustrating to go into medical facilities and see patients who are not being understood. So she urges other hospitals and clinics to look into adding interpreters to their staff, or at least to make use of translator hotlines that can be called day or night.

But Dana Richardson of the Wisconsin Hospital Association says many facilities are worried about the additional cost. "What we have seen in the state of Wisconsin overall is an increasing number of minority-ethnic groups coming in, and so it's becoming a greater cost for the health community to provide these services." Richardson says translator hotlines can cost at least $50 per hour. She says while hospitals recognize the value of having a multi-lingual flexibility, most simply cannot afford it.

The author of the language barrier study, Glenn Flores, suggests that U.S. medical schools could require their students to take medical Spanish, Chinese or other appropriate language. But for now, the number of immigrants is outpacing the health care industry's ability to provide adequate care in a language they can understand.

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